PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2003
Application orOoclcet Number
CLAIMS AS FILED - PART I
TOTAL CLAIMS
FOR
NUM8ERFILED
NUMBER EXTRA
TOTAL CHARGEABLE CLAIMS
minus 20=
INDEPENDENT CLAIMS
^rnlnus 3 =
MULTIPLE DEPENDENT CLAIM PRESENT
' If the ditference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED • PART II
AMENDMENT A *|
CUIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
Total
• 31^
Minus
Independent
•. ^
Minus
FIRST PRESENTATION OF MULTIPLE DEPEND^ CLAIM Q
(Column 1) fColumn 2) rcolumn 3)
AMENDMENTS |
CLAIMS
REMAtNtNG
AFTER
AMENDMENT
kiGHfeST
■ NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
Total
-*
Minus
Independent
tr
Minus
Mr*
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
(Column 1) (Column 2) (Columns)
MENDMENTC
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
Total
*
Minus
** '
Independent
*
Minus
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
SMALL ENTITY
TYPE
OTHER THAN
OR SMALL ENTITY
* If the entry in column 1 1s less than the entry in colunin 2, write '0' In column 3.
if the 'Highest Number Previously Paid For" IN THIS SPACE is less than 20. enter '20/
'—If the -Highest Number Previously Paid For' IN THIS SPACE Is less than 3. enter -3."
The 'Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1.
RATE
FEE
RATE
FEE
BASIC FE£
: 385.00
OR
BASIC FEE
770.00
XS9=
OR
X$1B=
X43=
OR
X86=
+ 145=
OR
+290=
TOTAL
OR
TOTAL
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
XS 9=
H
OR
X$18=
X43=
OR
X86=
+ 145=
+290=
TU lAL
ADDIT. FEE
|oR
TOTAL
ADDIT FFF
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X43=
OR
X86=^
+ 145=
OR
+290=
TOTAL
ADDIT FEE
OR ^^^^
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$9=
OR
X$18=
X43s=
OR
X86=
+145=
OR
+290=
TOTAL
ADDIT FEE
TOTAL
^" ADDIT FEE
FORM PTO^TS fRev. 10031
Pateni and Trademafl< Oflice. g.S, DEPARTMENT OF COMMERCE